Aim To assess how well prepared ST3 paediatric trainees felt they were prior to becoming middle grades. What steps had they taken to aid this and what measures had they felt could be implemented to increase preparedness? We compared their responses with a similar survey sent to consultant paediatricians responsible for their training.

Methods Mailshot with link to an online survey was mailed to all ST3 trainees in London and Eastern Deaneries. A further mailshot was sent to all college tutors for hospitals in the London Deanery. Trainees were emailed twice, in July 2012 and November 2013 meaning 2 different years of trainees were recruited. The college tutors were emailed just once in July 2012.

Results We received 73 trainee responses and 13 from consultants. ST3 trainees concerns were: 1) Concerns with leadership and decision making, 2) Night shifts without senior supervision, 3) Leading resuscitations, 4) Inability to perform procedures, (specifically neonatal intubation).

Most trainees felt they were not competent in dealing with common scenarios in community paediatrics, in particular safeguarding (69%) and outpatients 66%). They felt competent for general day-day work in general paediatrics (93%) and neonates (93%). The consultants felt trainees were lacking in their ability to run a neonatal resuscitation (78%), had inadequate practical skills (67%) and lacked in their leadership skills (56%)

Acting up was identified as a way to better prepare trainees by both the trainees and trainers, however the majority of ST3s (62%) had not acted-up as a registrar. Changes to current training with earlier exposure to child protection issues and extra time in neonates to improve procedural skills were also identified as ways to improve trainees’ competence.

Conclusion Our data has identified specific areas where existing training could be altered or new training measures instigated to ensure that registrars feel better prepared for their new roles. Their concerns can be split into human and clinical factors. It is possible to address many of these issues in SHO years, making trainees more confident in leadership and delegation.